SARS-CoV-2 Diagnostic Tests for Reopening of Borders: A Systematic Review and Meta-Analysis

Background: Diagnosis of SARS-CoV-2 plays an essential role for border screening to deter importation and transmission in the community. This study aims to compare the accuracy of various SARS-CoV-2 diagnostics in the general population and assess their potential utility as border screening for SARS-CoV-2 infection and immunity against SARS-CoV-2.Methods: Systematic literature searches were conducted in six electronic databases for studies reporting SARS-CoV-2 diagnostics. Meta-analysis and methodological assessment were conducted for all included studies. Performance of diagnostic tests was evaluated with pooled sensitivity, specificity and their respective 95% confidence intervals.Results: 5,416 unique studies were identified and 95 studies (at least 30,660 patients/samples) were included. Nuclei acid amplification tests (NAAT) consistently outperformed all other diagnostic methods regardless of geographical regions and selected viral genes with pooled sensitivity of 98% and pooled specificity of 99%. Point-of-care serology tests had reasonably high pooled sensitivity (69%), albeit lower than laboratory-based serology tests (89%), but both had high pooled specificity (96-98%). Diagnostic tests were consistently more sensitive among symptomatic patients than asymptomatic patients, while serology tests were more sensitive for later (≥7 days) than early stages (≤7 days) of the disease. Serology tests was less sensitive in American studies (64%, 95% CI 57%-70%) as compared to Chinese (98%, 95% CI: 95%-99%) and European studies (93%, 95% CI: 78%-99%).Conclusion: Point-of-care NAAT and serology tests are suitable for detecting SARS-CoV-2 infection and immunity against SARS-CoV-2, respectively as border screening.Funding Statement: Ministry of Defence (N-608-000-065-001)Declaration of Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.